Formation and Validation of the Healthy Diet Index (HDI) for Evaluation of Diet Quality in Healthcare

Jaana Lindström, Kirsikka Aittola, Auli Pölönen, Katri Hemiö, Kirsti Ahonen, Leila Karhunen, Reija Männikkö, Ulla Siljamäki-Ojansuu, Tanja Tilles-Tirkkonen, Eeva Virtanen, Jussi Pihlajamäki, Ursula Schwab, Jaana Lindström, Kirsikka Aittola, Auli Pölönen, Katri Hemiö, Kirsti Ahonen, Leila Karhunen, Reija Männikkö, Ulla Siljamäki-Ojansuu, Tanja Tilles-Tirkkonen, Eeva Virtanen, Jussi Pihlajamäki, Ursula Schwab

Abstract

Lack of tools to evaluate the quality of diet impedes dietary counselling in healthcare. We constructed a scoring for a validated food intake questionnaire, to measure the adherence to a healthy diet that prevents type 2 diabetes (T2D). The Healthy Diet Index (HDI) consists of seven weighted domains (meal pattern, grains, fruit and vegetables, fats, fish and meat, dairy, snacks and treats). We studied the correlations of the HDI with nutrient intakes calculated from 7-day food records among 52 men and 25 women, and associations of HDI with biomarkers and anthropometrics among 645 men and 2455 women. The HDI correlated inversely with total fat (Pearson's r = -0.37), saturated fat (r = -0.37), monounsaturated fat (r = -0.37), and the glycaemic index of diet (r = -0.32) and positively with carbohydrates (r = 0.23), protein (r = 0.25), fibre (r = 0.66), magnesium (r = 0.26), iron (r = 0.25), and vitamin D (r = 0.27), (p < 0.05 for all). In the linear regression model adjusted for BMI and age, HDI is associated inversely with waist circumference, concentrations of fasting and 2-h glucose and triglycerides in men and women, total and LDL cholesterol in women, and fasting insulin in men (p < 0.05 for all). The HDI proved to be a valid tool to measure adherence to a health-promoting diet and to support individualised dietary counselling.

Keywords: chronic diseases; diet quality; evaluation; prevention; type 2 diabetes; validation.

Conflict of interest statement

The authors declare no conflict of interest.The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

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